A two-year toxicology study of bisphenol A (BPA) in Sprague-Dawley rats: CLARITY-BPA core study results.

We report the data from the guideline-compliant two-year toxicology study conducted as part of the Consortium Linking Academic and Regulatory Insights on Bisphenol A Toxicity (CLARITY-BPA). BPA (0, 2.5, 25, 250, 2,500, and 25,000 µg/kg body weight (bw)/day) was administered daily by gavage in 0.3% carboxymethylcellulose vehicle to NCTR Sprague-Dawley rats from gestation day 6 through the start of parturition and then directly to pups from the day after birth until postnatal day 21 (stop-dose arm) or continuously until termination at one or two years. The stop-dose arm was included to assess the potential for any BPA effects that were due to developmental exposure. No BPA-related effects were evident in the in-life and non-histopathology data. Neoplastic and nonneoplastic lesions diagnosed in both females and males were common age-associated lesions that were variable across control and BPA-treated groups. The lack of consistent responses within the continuous- and stop-dose arms within and across tissues brought into question the plausible relationship of most of these lesions to BPA treatment. There was a possible relationship between the increased incidences of lesions in the female reproductive tract and the male pituitary and exposure to the 25,000 µg BPA/kg bw/day dose level.

Access to treatment and care associated with HIV infection among members of AIDS support groups in Thailand.

To examine the types and distributions of treatment received among persons living with HIV and AIDS (PLWHAs) in Thailand, we analyzed data collected during 2000 from 412 members of PLWHA support organizations in Bangkok and three upcountry northern provinces. Most (74%) of the respondents report ever receiving modern medical care for their HIV-related symptoms; 31% report ever using herbal treatments. Small proportions of those experiencing severe symptoms related to activity limitations report treatments with anti-retroviral medication, treatment for opportunistic infections or treatment for pain. Multivariate analysis suggests that the government's health card system plays an important role in keeping treatment costs down for PLWHAs and their families, that being open about one's HIV status to one's community is positively associated with receiving modern treatment for HIV-related ailments, that being female is negatively associated with receiving modern treatment and that living upcountry (as opposed to living in Bangkok) is associated with using herbal remedies. Policy implications of the findings are discussed.

Older people and AIDS: quantitative evidence of the impact in Thailand.

Discussions of the AIDS epidemic rarely consider the impact on older people except as infected persons. Virtually no systematic quantitative assessments exist of the involvement of parents or other older generation relatives in the living and caretaking arrangements of persons with AIDS in either the West or the developing world. We assess the extent of such types of involvement in Thailand, a country where substantial proportions of elderly parents depend on adult children for support and where co-residence with an adult child is common. Interviews with local key informants in the public health system in rural and urban communities provided quantitative information on a total of 963 adult cases who either had died of AIDS or were currently symptomatic. The results indicate that a substantial proportion of persons with AIDS move back to their communities of origin at some stage of the illness. Two-thirds of the adults who died of an AIDS-related disease either lived with or adjacent to a parent by the terminal stage of illness and a parent, usually the mother, acted as a main caregiver for about half. For 70%, either a parent or other older generation relative provided at least some care. The vast majority of the parents were aged 50 or more and many were aged 60 or older. This extent of older generation involvement appears to be far greater than in Western countries such as the US. We interpret the difference as reflecting the contrasting epidemiological and socio-cultural situations in Thailand and the West. The fact that older people in Thailand, and probably many other developing countries, are extensively impacted by the AIDS epidemic through their involvement with their infected adult children has important implications for public health programs that address caretaker education and social and economic support.

Adherence to travel health guidelines: the experience of Nigerian immigrants in Houston, Texas.

The objective of this study was to learn about the travel health practices of Nigerians in Houston, Texas, and to describe factors affecting adherence to recommendations for the prevention of malaria, typhoid, and hepatitis A set forth by the Centers for Disease Control and Prevention (CDC). Data were collected through focus group discussions and one-on-one interviews with travelers and health care providers. Data collection and analysis relied on a process-based framework that included questions about health and health-maintenance strategies before, during, and after travel. The cost of travel health services and the availability of vaccines and medications were important structural barriers to adherence. Perceptions of individual susceptibility and disease severity varied across the infections of interest. Travelers perceive themselves to be at risk for malaria, but are generally not concerned about its consequences. A notable exception is the fear of becoming symptomatic post-travel in the United States. Typhoid was less salient than malaria, and few had heard of or worried about acquiring hepatitis A. Stigma associated with the acquisition of travel-related conditions and the perceived incompetence of physicians to treat illnesses related to overseas travel, and malaria in particular, also affect preventive decisions and strategies. The results of the study have broad relevance for the traveling public and for programs and services that seek to improve travel health and travel health care.

Population pressure and fertility in pre-transition Thailand.

Before the demographic transition in Thailand, fertility was high, but not uniformly so. As in other pre-transition settings, Thai fertility responded to pressures and opportunities created by socioeconomic structure and land availability. Drawing upon provincial data from the 1947 and 1960 censuses of Thailand, we find a strong 'frontier effect' on Thai fertility in the 1950s. Fertility was higher in sparsely settled frontier provinces and lower in provinces with higher population density relative to cultivatable land. This finding is robust and holds up with controls for agricultural employment, land quality, and the sex ratio (an indicator of sex-selective migration). The effect of population pressure lowers the likelihood of marriage and of marital fertility. The findings from Thailand are consistent with the research of Easterlin on the nineteenth century United States and with other pre-transition societies. We suggest how demographic transition theory might be broadened to include fertility dynamics in pre-transition societies.

In the company of friends: peer influence on Thai male extramarital sex.

We explore some of the key social dynamics underlying patterns of male extramarital heterosexual behavior in Thailand. We analyze transcripts of focus group discussions and focused individual interviews conducted during 1993 and 1994 with married men and women living in both urban and rural areas of central Thailand. We discern several pathways of peer influence on extramarital commercial sex patronage that are common across our sites and interpret these peer effects in light of contemporary theories of social influence and sexual behavior.

Dimensions of AIDS knowledge and risky sexual practices: a study of northern Thai males.

The relation between AIDS-related knowledge and sexual risk-taking for a sample of young men living in northern Thailand was examined. Data were collected during the fall of 1991. The sample of 1472 men includes university students, soldiers, store clerks, and laborers. Recent commercial sex patronage was variable among the subgroups, and consistent condom use among these recent patrons was far from universal. Several important misunderstandings among our respondents regarding the AIDS virus were identified. These misconceptions were most common among men of relatively low socioeconomic status (laborers and soldiers). Factor analysis identified four distinct domains of AIDS knowledge among the student and soldier groups: knowledge about the mechanics of contagion, knowledge about the consequences of infection, knowledge about appropriate strategies for avoiding the virus, and knowledge regarding inappropriate strategies for avoiding the virus. In multivariate logistic regression, knowledge about inappropriate strategies and knowledge about contagion were the only two domains predictive of recent commercial sex patronage: Men with a relatively good understanding regarding the inefficacy of inappropriate strategies and the mechanics of contagion had lower odds of recent commercial sex patronage compared with men who had a relatively poor understanding of these domains of AIDS knowledge. In the condom use analysis, knowledge about both appropriate and inappropriate strategies was predictive of consistent condom use among recent commercial sex patrons. Thus programs should attempt to improve knowledge about strategies for avoiding the virus and the mechanics of contagion. Special efforts should be made to debunk existing myths about the perceived effectiveness of inappropriate strategies.

Socio-demographic correlates, HIV/AIDS-related cofactors, and measures of same-sex sexual behaviour among northern Thai male soldiers.

We use data from an anonymous self-administered 1991 survey of military personnel in northern Thailand to estimate overall levels of and socio-demographic differentials in same-sex sexual behaviour in this population. Additionally, we examine the relationship between sexual experience with another male and a variety of outcomes relevant to HIV prevention and policy. Overall, 16.3 per cent of the sexually active soldiers report ever having had anal or oral sex with other males. Same-sex sexual behaviour in this sample is positively associated with several indicators of higher socio-economic status. All of the men who report having had sex with other men report having had vaginal intercourse with females as well. Comparison of our estimate of same-sex sexual behaviour with those obtained from two similar samples drawn in 1991 suggests that the lower estimates observed in the other two studies are largely due to differences in data collection methods. Regarding the HIV/AIDS-related outcomes we examined, men who have had sex with other men are significantly more likely than those who have not to have ever injected drugs, to personally know someone with HIV/AIDS, to have had sex with a female prostitute in the last six months, and to have had a sexually transmitted disease in the last six months. In this sample, men who have had sex with other men are also less knowledgeable about HIV/AIDS than are men who have not. These results are discussed in terms of their implications for HIV-prevention policy in Thailand.

Two views of risky sexual practices among northern Thai males: the Health Belief Model and the Theory of Reasoned Action.

We apply the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA) to an analysis of unsafe sexual practices (inconsistent condom use with commercial sex workers) among men living in a high HIV-prevalence area. The empirical analysis is based primarily on a survey of sexual practices that was conducted by the authors during the fall of 1991. The survey sample includes university undergraduates, soldiers, clerks, and laborers living in Chiang Mai, Thailand. There is much overlap between the two theories, and both provide useful frameworks for examining condom use in this population. However, the Bayes Information Criterion (BIC) approach provides very strong evidence that TRA is the more plausible model, given the data. The success of TRA appears to be due to its more adequate incorporation of peer group effects. Other covariates positively associated with consistent condom use in the multivariate models include knowledge about the consequences of HIV infection, knowledge about the benefits of condom use for preventing infection, and positive attitudes about condoms.

Birthweight-specific infant mortality risks for Native Americans and whites, United States, 1960 and 1984.

We used NCHS natality and linked-birth/death certificate tapes to compare birthweight-specific neonatal and postneonatal mortality risks for Native Americans and whites in 1960 and in 1984. The birthweight distributions for the two groups were similar both years. Native American neonatal mortality risk dropped from 20.2 in 1960 to 5.2 in 1984, and the relative risk for Native Americans with respect to whites fell from 1.31 in 1960 to a nonsignificant difference in 1984. Postneonatal mortality risks for Native Americans fell from 27.5 in 1960 to 6.2 in 1984, with a drop in the relative risk from 5.2 to 2.1. Although the relative improvements for Native Americans were highest in postneonatal survival, Native Americans still had over twice the level of white postneonatal mortality. Birthweight was positively associated with survival for both groups, but the odds of Native American neonatal death were affected less by low and very low birthweights. For both groups, improvements in neonatal mortality were highest at the lower birthweights, while the gains in postneonatal survival benefitted normal and high birthweight infants most.

HIV-infected women and sexual risk reduction: the relevance of existing models of behavior change.

This article utilizes constructs of the AIDS Risk Reduction Model (ARRM) to examine condom use in a sample of 215 HIV-infected women in New Jersey. We find evidence that processes affecting condom use in HIV-infected individuals are similar to those found in HIV-negative individuals. Results suggest that partner-related factors are important to consistent condom use in HIV-infected women. Women are more likely to use condoms consistently if they have high perceived power to influence their partner's condom use, have partners who are HIV seronegative, and have partners who do not want more children. Conflicts with the partner decrease the probability of consistent condom use. Also negatively associated with condom use are the woman's use of drugs and/or alcohol and her belief that condoms reduce sexual enjoyment. Implications of these findings for designing interventions for HIV-infected women are considered.

PIP: This study examined the extent to which the major constructs of traditional psychosocial models of preventive health behavior, as articulated in the 3-stage AIDS Risk Reduction Model (ARRM), can help to explain factors motivating preventive behavior and condom use in a sample of 215 HIV-infected women in 3 high HIV-prevalence cities in northern New Jersey, who reported having a primary sexual partner and being aware of their HIV status in the 4 weeks prior to the interview. They were part of a federally funded project recruiting 370 HIV-infected women between 1989 and 1991. 80% were of a minority race, 79% were currently receiving welfare, nearly half did not complete high school, and only 15% were currently married. Only 48% reported using condoms consistently with their primary partner. Results of the multiple regression model showed that women reporting a lot of power with respect to their partner's condom use had odds of consistent condom use 23.5 times higher than women reporting less influence. Women with partners who were HIV positive or of unknown serostatus had odds of consistent condom use that were only 0.29 as high as women with HIV-negative partners. Women reporting that their partners did not want more children were 3.19 times more likely to use condoms consistently than women with partners who wanted children in the future. Women reporting serious arguments with the partner in the previous 6 months had odds of consistent condom use that were only 0.41 as high as women in less conflicted relationships. Women who believed that condoms decreased their sexual pleasure had odds of consistent condom use only 0.33 as high as women expressing more favorable attitudes. Similarly, the use of drugs or alcohol in the previous 4 weeks decreased the odds of consistent condom use by a factor of 0.38. None of the interaction terms tested showed a significant association with condom use.

Sexual activity among never-married men in northern Thailand.

We use data collected in 1991 to investigate sexual activity among never-married men in Thailand, with a focus on age at first intercourse, characteristics of sexual partners, and conditions under which men visit prostitutes. We sampled men from a broad spectrum of northern Thai society, including university undergraduates, soldiers, and semi-skilled/unskilled workers. We found that except for the students, the majority of each subsample is sexually experienced; prostitutes are the most common type of sexual partner for all groups. Alcohol consumption is associated with several measures of sexual activity. Condom use with prostitutes varies among the subsamples. Among men who have both prostitute and nonprostitute partners, the majority of those who do not use condoms with prostitutes also do not use condoms with their nonprostitute partners. We consider the implications of these results for the AIDS epidemic in Thailand.

Breastfeeding and waiting time to conception for Malay women: a tale of two surveys.

This study investigates the unusual relationship between breastfeeding and waiting time to conception in Malaysia as reported in Goldman et al. (1987). Using data from the Malaysian World Fertility Survey (MWFS), Goldman and her colleagues (1987) find that noncontracepting Malaysian women have an unusually long waiting time to conception, given their relatively short durations of breastfeeding. This study provides a similar analysis using data from the Malaysian Family Life Survey (MFLS) and finds a more typical relationship. I conclude that the distinction between full and partial breastfeeding made to respondents of the MFLS probably led to more reliable responses to questions about breastfeeding duration, especially for women who breastfeed for long durations.

PIP: In 1987, Goldman et al. analyzed data from the Malaysian World Fertility Survey (MWFS) and found that noncontracepting Malaysian women had a birth interval 8 months longer than expected from their relatively short duration of breast feeding (5.9 months). Analysis by ethnic group showed that it was the Malays who had the longer birth interval, with the Chinese women close to predicted times. In the present study, an attempt was made to reproduce Goldman's findings and then to compute comparable measures from data from the Malaysian Family Life Survey (MFLS) in order to explain this phenomenon. The MWFS, conducted during August-December 1974, asked if a baby was breast fed and, if so, for how many months. Waiting time to conception was calculated, with median waiting times and medium breast feeding times calculated using increment/decrement tables. Current decrement calculations produced estimates very close to Goldman's. In the MFLS, conducted between August 1976 and August 1977, women were asked if they breast fed, even if it was for a few days. Median birth intervals and breast-feeding durations were calculated using lifetables for births between January 1972 and December 1974. Results showed that median birth intervals were very similar for the 2 surveys, but median duration of breast feeding was about double in the MFLS for all breast-fed babies born in 1972-74, with the discrepancy in the 2 surveys holding true for the Malays and not the Chinese. Thus, a problem in the interpretation of the breast-feeding question by MWFS respondents seems to account for the difference in breast-feeding durations given in the 2 surveys and also for the difference between the MWFS and other World Fertility Surveys (WFS). Malay women seem to have limited their reporting of months of breast feeding to months of full breast feeding. The Chinese women may have had less problem in this regard since the Chinese duration of any breast feeding was very short. Also, weaning may be a more distinct event for the Chinese women, whereas the Malays may extend weaning over a longer period of time. Responses may also have been influenced by the relative unpopularity of breast feeding in Malaysia during the early 1970s as compared to other WFS countries. Substituting MFLS data for breast feeding duration data reported in the MWFS increased Malaysia's waiting time to 18 months, only 3 months less than the observed WFS value of 21 months. This illustrates the importance of phrasing in questionnaires. Even the more detailed questions in the MFLS, however, do not provide data which sufficiently explain how Malaysia differed from other WFS countries during the 1970s. Further research on the balance of breast feeding and supplemental feeding and on perceived social approval is required to answer this question.

Young, low-parity women: critical target group for family planning in Bangladesh.

PIP: After years of persistent low levels, contraceptive prevalence in Bangladesh is beginning to rise, although slowly. Much of the increase in contraceptive prevalence in recent years is attributable to higher rates of acceptance among relatively older, high-parity couples. While rather high increases in contraceptive prevalence have been achieved for women with 3 or more living children, the gain for families with 2 or fewer living children have not been impressive. The importance of targeting young, low-parity couples for family planning services cannot be overemphasized. Women 15-24 years old make up 44% of all women of reproductive age. Also, there are large cohorts of girls just below reproductive age that will soon begin having children. Recent studies show a surprisingly high demand for contraception among younger couples. A complete registration of eligible couples in each fieldworker's area must be completed. Fieldworker and supervisor training must be adapted to focus on this target group. The provision of maternal-child health services becomes increasingly important as more young couples are brought into the program. Temporary birth control methods should make up a larger proportion of the country's method-mix target. The current family planning media campaign should highlight the health benefits for mother and child of family planning used for spacing. The government should continue to promote the small family norm. More effort should be made to influence community and religious leaders and men in general. Immunization and other child survival activities should be intensified.^ieng

Birthweight-specific infant mortality for native Americans compared with whites, six states, 1980.

We used data from the National Infant Mortality Surveillance (NIMS) project to compare birthweights and birthweight-specific mortality risks among Native American and White infants. Because race categories in NIMS were limited to White, Black, and all, we studied six states in which greater than 85 per cent of newborns who were neither White nor Black were Native American. In these states, the infant mortality risk (IMR) among Native Americans was 15.3 deaths per 1,000 live births compared with 8.7 deaths among Whites, relative risk (RR) = 1.8 (95% CI = 1.5-2.0). The percentage of Native American infants with less than 2,500 g birthweights was 5.8 per cent versus 5.0 per cent for White infants. Birthweight-specific neonatal mortality risks were similar for the two race groups, but birthweight-specific postneonatal mortality risks (PNMRs) were more than three times as high among Native Americans compared with Whites for infants of greater than or equal to 2,500 g birthweight. PNMRs were elevated for most causes of death and for all categories for maternal age, educational attainment, trimester prenatal care began, and number of previous live births. Leading causes of postneonatal death among Native Americans of greater than or equal to 2,500 g birthweight were sudden infant death syndrome and infections.